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Novel synthetic opioids (NSOs), such as fentanyl, fentanyl derivatives and newly emerging analogues, have become increasingly available in the recreational drug market worldwide in recent years. Fentanyl is a synthetic phenylpiperidine with analgesic and anaesthetic properties. It is available as a stand-alone product, as an adulterant in heroin, cocaine and amphetamines or as a constituent of illicit prescription medications. In addition to fentanyl and the fentanyl analogues such as carfentanyl, acetylfentanyl, butyrylfentanyl and furanylfentanyl, numerous other potent NSOs have recently appeared on the illicit drug market; many of these have chemical structures that do not resemble morphine or fentanyl, however, they are active at the μ-opioid receptor. These novel synthetic opioids include the benzamide-based opioids U-47700 and AH-7921, tianeptine and MT-45. Novel synthetic opioids are amongst the most abundant and potentially lethal new psychoactive substance (NPS) chemical subclass. Currently, the true prevalence of use of NSOs is hard to determine as newer modified compounds that circumvent existing drug laws are being synthetized and introduced into the drug market on a regular basis. This necessitates the availability of reference material and rapid analytical method developments to keep track of these emerging opioids. Opioids, whether natural or synthetic, cause respiratory depression leading to acute hypoxia and hypercapnia through central nervous system depression. This chapter will focus on selected synthetic opioids including fentanyl, its NPS derivatives, and other common NSOs. The physical and chemical properties, pharmacology, toxicity and abuse potential of these synthetic opioids are discussed in this chapter.

Synthetic amphetamine derivatives, benzofurans, and benzodifurans are commonly used, ever-growing number of synthetic substances. This chapter reviews the pharmacology, prevalence of use worldwide, as well as evidence of toxicity in animals, and in humans, using case reports of toxicity and deaths when available, with a goal of providing a better understanding of availability, abuse potential, and burden of toxicity from common forms of these substances. Amphetamine derivatives share a common phenylethylamine chemical skeleton that, with subtle structural modifications, can result in a diverse array of drugs capable of producing varied and discrete clinical effects. The mechanism of action of these agents is stimulated release of biogenic amine neurotransmitters, inhibition of their reuptake, and prevention of their degradation. The paucity of reliable medical information regarding the effects of novel amphetamine derivatives in humans underscores both the need for confirmatory testing in suspected cases and for the clinician to be familiar with structure activity relationships and their expected physiological result. In this chapter we review experimental animal data, self-reported human clinical effects and existing case reports and case series to highlight the clinical effects of amphetamine derivatives. This is a continuingly developing field with new drugs being developed and marketed on an ongoing basis. Drugs are therefore classified by chemical and clinical similarity to assist clinicians with the prediction of potential adverse effects as newer drugs continue to emerge. Benzofurans are members of the amphetamine and phenylethylamine classes. 6-APB and 5-APB have recently been identified as single furan ring benzofuran compounds used as recreational drugs, producing sympathetic system stimulation and euphoria. There is little information available regarding their toxicity. They are postulated to exert their effects through stimulation of catecholamine receptors and as 5-HT receptor agonists. Benzodifurans (containing 2 heterocyclic rings) including bromo‑dragonFLY and 2-CB-FLY are ring-substituted phenylethylamines with potent 5HT2A agonist effects and predominant hallucinogenic clinical effects. Bromo-dragonFLY toxicity produces excess sympathomimetic activity and severe vasoconstriction, in some cases resulting in limb amputation. Deaths secondary to bromo‑dragonFLY and mis-identified 2-CB-FLY (containing bromo‑dragonFLY) have occurred in Europe and the USA. Recent surveys of drug users indicate that 6-APB is the most commonly used recreational benzofuran in the UK; although compared to established, classical recreational drugs and other novel psychoactive substances 6-APB and other drugs in this class are rarely used.

Introduction Most countries have laws against driving while impaired by drugs. However, in many countries, including Canada and the United States, police must have individualized suspicion that the driver has recently used an impairing substance before they can gather the evidence required for laying a criminal charge. This report studies police documentation of drug involvement among drivers who had a motor-vehicle crash after using an impairing substance. Methods We obtained blood samples and police reports on injured drivers treated in participating British Columbia trauma centres following a crash. Blood was analyzed for alcohol, cannabinoids, other recreational drugs, and impairing medications. Corresponding police reports were examined to determine whether police recorded that the driver’s ability was impaired by alcohol, drug or medication, or that one of these substances was a possible contributory factor in the crash. Results We obtained blood samples and corresponding police reports on 1816 injured drivers. Mean driver age was 44 years, 63.2% were male, and 25.8% were admitted to hospital. Alcohol was detected in 272 drivers (15.0%), THC (tetrahydrocannabinol - the principal psychoactive ingredient in cannabis) in 136 (7.5%), other recreational drugs in 166 (9.1%), and potentially impairing medications in 363 (20.0%). Police reported that the driver’s ability was impaired by alcohol or that alcohol was a possible contributory factor in 64.1% of the crashes involving alcohol-positive drivers. Drug impairment or drugs as a possible contributory factor was reported in 5.9% of the crashes involving THC-positive drivers, and in 16.9% of the crashes involving drivers who tested positive for other recreational drugs. Medication impairment was reported in only 2.2% of the crashes involving medication-positive drivers. Conclusion Police seldom document drug involvement in drivers who were in a crash after using cannabis, other recreational drugs or potentially impairing medications. This finding raises serious concerns about the ability of the police to effectively enforce current drug-impaired driving laws and public health officials’ continued reliance on police crash reports to monitor the prevalence of drug-impaired driving.

“We have Mr. Jordan, a 35-year-old African-American man with a past medical history significant for recurrent syncope admitted for further management of critical aortic stenosis with a mean gradient of 100 mm Hg. He has no medical insurance, is unemployed, and has a history of recreational drug

Recreational drug use has recently shifted from primarily illicit substances to an increasing number of prescription medications. Neurologic complications of these substances include disorders of the central and peripheral nervous system and range from mild agitation, as is seen in some patients when intoxicated with methamphetamine, to life-threatening intracerebral hemorrhage from cocaine intoxication or the toxic leukoencephalopathy resulting from vaporized opiates. In addition, there is increasing recognition that chronic abuse of some of these substances can lead to long-term neurologic and psychiatric sequelae. New substances are constantly emerging and clinicians need to stay up-to-date and vigilant regarding their neurologic manifestations.

This chapter describes cannabis use and risk for psychosis, the drug's long-term effects on IQ and the modification of THC-related effects by terpenes. These discussions of cannabis raise much wider issues that apply to the myriad of recreational drugs affecting mood and consciousness from legal everyday examples, such as caffeine, tobacco, and alcohol; through the illegal, including ecstasy, marijuana, opioids, and psychedelics. cannabis produces a wide diversity of behavioral and psychological phenomena, some of which are explained by knowledge of the distribution of cannabinoid receptors in the brain, and experiments that indicate how drug-induced alterations in various brain circuits are associated with feelings and behaviors influenced by the drug. The “happy, hungry, horny” changes effected by the drug, along with perceptual and timekeeping alterations, seem more readily explained than the drug's effects on more complex and incompletely understood mental functions, such as sense of self and transcendence.

Kratom is an herbal compound that has been used as a recreational drug though is not regulated by the Food and Drug Administration. We report a 19-year-old male with recurrent seizures that developed during daily Kratom abuse as a self-treatment for anxiety. Following recurrent focal impaired awareness seizures in addition to generalized tonic–clonic seizures, he was begun on anti-seizure drugs. Seizures subsided after completing rehabilitation. Brain MRI at 29 months revealed bilaterally symmetric T1-hyperintensity in globus pallidus, subthalamic nuclei, and cerebral peduncles. Our case suggests Kratom abuse may be associated with structural brain lesions on MRI and symptomatic focal epilepsy., Highlights • Kratom has become a popular recreational drug in the West. • Kratom works as a stimulant but at high doses it has sedative/anti-nociceptive effects. • Kratom abuse may be associated with structural brain lesions on MRI. • No standard methods exist to detect Kratom or its metabolites on drug screening.

Nicotine is one of the most commonly used recreational drugs. It is contained in tobacco plant products that can be either chewed, sucked, or smoked. More recently, vaping has become popular whereby nicotine is obtained via a liquid in an electronic cigarette. Regardless of the mode by which tobacco or its products are used, there is considerable evidence that nicotine has many neuroactive effects and is highly addictive. The detailed mechanisms relevant to the neurological effects of nicotine and treatment modalities for nicotine addiction are relatively recent discoveries in the timescale of tobacco usage. To aid further understanding, this chapter lists the resources on the regulatory and professional bodies, journals, books, and websites that are relevant to an evidence-based approach to the neuroscience of nicotine.

Ethanol, or alcohol, is one of the most commonly used recreational drugs. On a global basis, alcohol misuse causes the deaths of 3 million people each year (WHO, 2014). This is about 1 in 17 deaths. Alcohol misuse also causes many neurological pathologies. In terms of the global burden of disease, neuropsychiatric disorders contribute to about 25% of all alcohol-attributable disability-adjusted life years (DALYS). The detailed mechanisms related to the neurological effects of alcohol and treatments are relatively recent advances within alcohol-related research. This chapter lists resources of the regulatory bodies, professional societies, journals, books, and websites that are relevant to an evidence-based approach to the neuroscience of alcohol and alcohol treatments. For example, we list over 100 websites and 90 recommended books.

The number of new psychoactive substances (NPS) on the recreational drug market has increased rapidly in the last years, creating serious challenges for public health agencies and law enforcement authorities. Epidemiological surveys and forensic analyses to monitor the consumption of these substances face some limitations for investigating their use on a large scale in a shifting market. The aim of this work was to develop a comprehensive and flexible screening approach for assessing the presence of NPS in urban wastewater by liquid chromatography-high resolution mass spectrometry (LC-HRMS). Almost 200 substances were selected as “priority NPS” among those most frequently and recently reported by the Early Warning Systems (EWS) of different agencies and were included in the screening. Wastewater samples were collected from several cities all over Europe in 2016 and 2017, extracted using different solid-phase cartridges and analysed by LC-HRMS. The screening workflow comprised two successive analytical steps and compounds were identified and confirmed following specific criteria from the current guidelines. Thirteen NPS were identified at different confidence levels by using analytical standards or information from libraries and literature, and about half of them were phenethylamines. As far as we know, this is the first time that four of them (i.e. 3,4-dimethoxy-α-pyrrolidinovalerophenone, para-methoxyamphetamine, 2-phenethylamine and α – methyltryptamine) have been found in urban wastewater. The proposed screening approach was successfully applied in the largest NPS European wastewater monitoring, providing an innovative and easily adapted procedure for investigating NPS. In the light of current challenges and specific future research issues, this approach may complement epidemiological information and help in establishing measures for public health protection.

“Recreational drugs” are defined as substances “used without medical justification for…psychoactive effects often in the belief that occasional use of such a substance is not habit-forming or addictive.”

Potential for exposure to illegal drugs may exist for many companion animals, horses, and even livestock on occasions. Marijuana is one of the most prevalent recreational drugs in the world after legal substances ethanol and nicotine. Among companion animals, dogs are the most susceptible to poisoning with illicit substances though problems occasionally arise in cats, ferrets, birds, or other animals in the household. Diagnostic laboratories have screens available to detect the presence of many illegal drugs, but these screens take time and may be expensive. Awareness of the animal's home situation, including the neighborhood or the presence or adolescent children in the household, may be helpful in determining the potential for exposure to illegal substances. Quantity of the drug ingested and severity of clinical signs are important for determining prognosis with many drugs. However some drugs, such as marijuana, may cause severe central nervous system signs, but affected animals have an excellent prognosis with early and appropriate intervention.

A wide variety of herbal smoking blends containing synthetic cannabinoid receptor agonist (synthetic cannabinoids), collectively referred to as “Spice” products, are continuously introduced, by mainly online sale, to the recreational drugs market. If the psychoactive additives become classified, they are rapidly replaced by new structural analogs, to maintain a legal standing of the products (legal highs). Many of these substances are highly potent cannabinoid receptor full agonists with 100-fold or more higher affinity than Δ9-tetrahydrocannabinol (THC) that have not undergone the standard human safety testing required for pharmaceuticals. This sometimes causes problems with overdosing, and poses a risk for severe medical and psychiatric complications. Furthermore, because little is known initially about the metabolic pattern of synthetic cannabinoids, including them in analytical methods for routine drug testing represents an ongoing challenge for the clinical and forensic toxicology laboratories, and also brings major challenges to the control of new drugs. It can be assumed that further structural analogs with cannabinoid receptor activity from different chemical groups will continue to appear in Spice products.

The association between cannabis and psychosis has long been a matter of debate, with cannabis widely perceived as a harmless recreational drug. However, epidemiological studies have shown that cannabis use is associated with a higher risk of developing psychosis later in life. This chapter is an overview of the link between cannabis and psychosis, focusing on the nature of association, biological plausibility, and implications.

Human presence in the Antarctic is increasing due to research activities and the rise in tourism. These activities contribute a number of potentially hazardous substances. The aim of this study is to conduct the first characterisation of the pharmaceuticals and recreational drugs present in the northern Antarctic Peninsula region, and to assess the potential environmental risk they pose to the environment. The study consisted of a single sampling of ten water samples from different sources, including streams, ponds, glacier drains, and a wastewater discharge into the sea. Twenty-five selected pharmaceuticals and 21 recreational drugs were analysed. The highest concentrations were found for the analgesics acetaminophen (48.74 μg L−1), diclofenac (15.09 μg L−1) and ibuprofen (10.05 μg L−1), and for the stimulant caffeine (71.33 μg L−1). All these substances were detected in waters that were discharged directly into the ocean without any prior purification processes. The hazard quotient (HQ) values for ibuprofen, diclofenac and acetaminophen were far in excess of 10 at several sampling points. The concentrations of each substance measured and used as measured environmental concentration values for the HQ calculations are based on a one-time sampling. The Toxic Unit values indicate that analgesics and anti-inflammatories are the therapeutic group responsible for the highest toxic burden. This study is the first to analyse a wide range of substances and to determine the presence of pharmaceuticals and psychotropic drugs in the Antarctic Peninsula region. We believe it can serve as a starting point to focus attention on the need for continued environmental monitoring of these substances in the water cycle, especially in protected regions such as the Antarctic. This will determine whether pharmaceuticals and recreational drugs are hazardous to the environment and, if so, can be used as the basis for risk-assessment studies to prioritise the exposure to risk., Research Group and Teaching in Environmental Toxicology and Risk Assessment, Universidad Rey Juan Carlos, España, Instituto Geológico y Minero de España, España, Water and Soil Quality Research Group, Instituto de Diagnóstico Ambiental y Estudios del Agua, España, Water and Soil Quality Research Group, Consejo Superior de Investigaciones Científicas, España, Institut Català de Recerca de l'Aigua, Parc Científic i Tecnològic de la Universitat de Girona, España, Departamento de Geología y Geoquímica, Universidad Autónoma de Madrid, España, Instituto Nacional de Agua, Argentina, Departamento de Biología y Geología, Universidad Rey Juan Carlos, España, Departamento de Medicina y Cirugía, Psicología, Medicina Preventiva y Salud Pública y Microbiología e Inmunología Médica, Universidad Rey Juan Carlos, España

In recent years, recreational use of Salvia divinorum (Lamiaceae), a herbal drug that contains a hallucinogenic ingredient, salvinorin A, has become a new phenomenon among young drug users. In Taiwan, as in many other countries, dry leaves of S. divinorum and its related concentrated extract products are available via the Internet. Besides S. divinorum, there are many endemic Salvia species whose salvinorin A content is yet unknown. To understand the abuse liability of these products, the aim of this study was to assess the concentration of salvinorin A in endemic Salvia species and Internet-available salvinorin A-related products. Samples of S. divinorum were purchased via the Internet and samples of eight endemic species of Salvia were collected in Taiwan, including S. arisanensis Hayata, S. coccinea Juss. ex Murr, S. hayatana Makino ex Hayata, S. japonica Thumb. ex Murr, S. nipponica Miq. Var. formosana (Hayata) Kudo, S. scapiformis Hance, S. tashiroi Hayata. Icon. PI. Formosan, and S. keitaoensis Hayata. The content of salvinorin A was determined by high performance liquid chromatography (HPLC). Salvinorin A was extracted from the dry leaves of S. divinorum and endemic species of Salvia with methanol and analyzed on a C-18 column by isocratic elution with a mobile phase of acetonitrile–water. Salvinorin A was detected in S. divinorum, but not in the endemic Salvia species of Taiwan. Therefore, endemic species of Salvia in Taiwan may not possess hallucinogenic potential. However, the potential harm from S. divinorum available via the Internet should be thoroughly assessed in Taiwan, and control measures similar to those implemented in many other countries should be considered.

© 2016 Elsevier LtdTwo studies explored the differences in tastant (salt, sour, bitter, sweet and spicy) concentration preference between recreational drug users and abstainers. In study 1, 250 opportunistically recruited abstainers, cannabis only users and multiple-drug users completed psychometric questionnaires and a concentration preference tastant test. In study 2, 76 participants purposefully recruited abstainers, daily tobacco users, recreational cannabis users and daily cannabis users completed the same protocol as study 1. Study 1 demonstrated that both multiple drug users and cannabis users had a higher preference for salt and sour tastants than abstainers. Study 2 showed that daily cannabis and tobacco users had a higher preference for sweet and spicy tastants than recreational cannabis users and abstainers. As predicted, recreational drug users scored higher on both sensation-seeking and impulsivity compared to abstainers. Participants who habitually smoke tobacco or cannabis daily have different concentration preference for specific tastants. The aim of the current study was to provide an explanation for the inconsistency in published results on taste preferences in recreational drug users. The data offered in this paper indicate that variation in recruitment strategy, definition of ‘drug users’, and mode of drug delivery, as well as multiple drug use, may explain the preference for stronger tastants in habitual drug users. Future research exploring the psychobiological underpinnings of the impact of drug use on food preferences should carefully define recreational drug user groups.

This chapter focuses on what is known about the acute effects of ±3,4-methylenedioxymethamphetamine (MDMA) based on findings from human behavioral pharmacology studies. There is a relatively large database from preclinical studies that suggests that MDMA may have long-term adverse effects including neurotoxicity and mood and cognitive disruptions. However, these studies have several limitations that make it difficult to draw conclusions about the specific risks for humans. Human behavioral pharmacology provides complementary information about both the positive effects and the negative effects of MDMA in order to better assess the drug’s risk/benefit ratio. Using this methodology, researchers have observed several effects relevant to both the safety of recreational drug users and for the potential use of the drug as a psychotherapeutic. For example, the drug produces: (1) dose-dependent increases in heart rate, blood pressure, and body temperature; (2) increases in subjective feelings of euphoria and sociability; and (3) alters social processing and behavior. Overall, human behavioral pharmacological studies of MDMA provide important information about the risk/benefit ratio of the drug, which will aid in the development of policies concerning therapeutic and recreational use.

The popularity of new psychoactive substances among drug users has become a public health concern worldwide. New psychoactive substances are a large group of synthetic and plant derivatives mimicking the psychotropic effects of traditional and illicit drugs of abuse. These substances are generally sold in specialized street shops known as “head” or “smart” shops and in online stores. New psychoactive substances have been associated with numerous cases of severe intoxication and deaths across the world. In this chapter we examine this phenomenon, focusing our attention on the most popular and widespread substances appearing on the recreational drug market: synthetic cathinones and synthetic cannabinoids.

Ketamine was first synthesized in the early 1960s for use as an anesthetic and analgesic by noncompetitive antagonism of the N-methyl- d -aspartate receptor. However, the induction of unusual and substantial changes in perception and emotion (psychedelic effects) made ketamine a drug of abuse, used in a wide range of public and private settings with increasing consume all over the world. This pharmaceutical product displays a wide safety margin, but toxicological and adverse effects may occur. In that sense, increasing reports have shown cognitive impairment, hepatotoxicity, urological, and gastrointestinal toxicity associated with the recreational use of ketamine. Also, as ketamine abusers increase, concerns over its physical and psychological consequences have been raised despite the difficulty in determining its prevalence. Notwithstanding its adverse effects, the psychedelic effects of ketamine have been appointed as a promising therapy for the treatment of heroin addiction and alcoholism. Thus, further investigation should be conducted to clarify the severity of the pathophysiological conditions associated with nonmedical ketamine use in order to minimize risks.

Marijuana, behind only tobacco and alcohol, is the most popular recreational drug in America with prevalence rates of use rising over the past decade. A wide range of research has highlighted neurocognitive deficits associated with marijuana use, particularly when initiated during childhood or adolescence. Neuroimaging, describing alterations to brain structure and function, has begun to provide a picture of possible mechanisms associated with the deleterious effects of marijuana use. This chapter provides a neurodevelopmental framework from which recent data on brain structural and functional abnormalities associated with marijuana use is reviewed. Based on the current data, we provide aims for future studies to more clearly delineate the effects of marijuana on the developing brain and to define underlying mechanisms of the potential long-term negative consequences of marijuana use.

When drugs affect the cardiovascular system, the complication cannot be considered minor, as the consequence will be an effect on cardiac contractile function or rhythm. For the purpose of this chapter, toxic agents refer to medicinal or recreational drugs, and toxins present in food, drink, or nutritional supplements. In general, agents that are “toxic” to the heart induce injury through one (or more) of the following mechanisms: direct toxicity, idiosyncratic reaction related to abnormal metabolism, hypersensitivity, overdose, and/or drug interactions. The heart has a very limited repertoire of responses to disease: (1) the heart can fail as a pump, or (2) the electrical system can fail resulting in a variety of conduction problems and arrhythmias. While the manifestations of cardiac injury are limited, the pathologic changes responsible for the dysfunction are more protein. This diversity of patterns of injury is especially true for injury to the heart by toxic agents.

In recent years mephedrone (4-methylmethcathinone) has gained popularity over other classified recreational drugs of abuse due to its low price and availability on the Internet. Because of its unwanted toxic and possibly lethal effects it is currently a matter of concern to public health worldwide. The significant qualitative and quantitative variation in content of the purportedly mephedrone-containing products on the market as well as the tendency to assume mephedrone combined with other drugs is challenging in terms of analytical identification in both street and biological samples. Furthermore, the many possible mephedrone-based combinations limit the possibilities of narrowing the clinical presentation of mephedrone intoxication, hence impairing the effectiveness of medical intervention. For these reasons awareness on the matter of mephedrone recreational use is necessary among clinicians and forensic scientists and, at least, the most common compounds derived from the combination of mephedrone and other substances should be included in toxicology screening procedures.

Heroin is commonly abused as a recreational drug and results in huge social, economical, individual, and public health hazards. Heroin affects many organs in abusers' bodies. The most well studied effects of heroin on the brain are dependence and tolerance after extended use. However, heroin also has some less commonly reported effects on the brain. For example, ischemic cerebrovascular accident following heroin use is an infrequent consequence of heroin abuse and is primarily related to impurities in the drug preparation. Another rare consequence of heroin abuse is toxic leukoencephalopathy. Although this is usually associated with heroin inhalation, its precise etiology is not clear. Here, we review existing cases for these two uncommon pathologies as well as suggested mechanisms for them, including mitochondrial impairment.

Cannabis (marijuana, hashish, and hemp) has been entwined with human society from the dawn of history. For hundreds of years the hemp plant was used to make rope, sails, and other durable products while its resins were considered to have useful medicinal properties often with religious associations. In recent years it has been used by millions as a recreational drug. Extensive research has found few serious consequences from its use. It causes no deaths and is less addictive than most other intoxicating substances. It can aggravate existing mental illness. Recently it has enjoyed new favor for its medicinal properties.

Ecstasy (3,4-methylenedioxymethamphetamine, MDMA) is a widely used recreational drug among young adults. In laboratory animals MDMA induces selective and persistent damage to central serotonergic neurons. The present chapter critically reviews current evidence for harmful effects of recreational ecstasy use on hippocampal memory functioning. The chapter covers findings in human ecstasy users from neurocognitive and neuroimaging studies and is completed by a brief outlook on the molecular genetics of ecstasy use. Although research in recreational ecstasy users is challenging and faces methodological issues, a considerable amount of neurocognitive and neuroimaging studies have provided accumulating evidence for memory impairments and altered hippocampal functioning in ecstasy users.

Abusive drugs are used recreationally by young adults worldwide and are often used in combination with different abusive agents. In this brief review, we summarize the effects of some commonly used recreational drugs like ketamine, amphetamine, cocaine, and opioid and their interaction with each other and with some Chinese herbal agents. We present the therapeutic value of the commonly used Chinese herbs like Chrysanthemum sp., Gastrodia elata , Rheum rhabarbarum , Panax ginseng , and notoginseng. Other herbs with functions related to the central nervous system, for example, Radix zanthoxyli , Corydalis yanhusuo , and Salvia miltiorrhiza , are also discussed.

New psychoactive substances are found mainly in the recreational drug market. These substances include synthetic cannabinoids, synthetic cathinones, phenethylamines, piperazines, pipradrols, tryptamines, aminoindanes, indoles, benzofurans, phencyclidine-type substances, plant-based substances, and opiate type substances and are mainly manufactured in clandestine laboratories to mimic the effects of current controlled drugs. For many of these substances there is a paucity of information about the actual effects, whether positive or negative, long-term complications, and potential for dependence.

Illicit drugs occupy an ambivalent position in late modern society; one that revolves around the twin themes of pleasure and disapproval. Drawing on Freudian psychoanalysis and Eliasian sociology this article considers how people, particularly those who use drugs, negotiate such ambivalence. Patterns of drug use and associated attitudes are examined on the basis of the Crime Survey for England and Wales and a specialist survey of largely recreational drug users in the United Kingdom. Although illicit drugs have become increasingly familiar, their use is still widely thought to be harmful and morally dubious, creating a series of challenges for those who engage in such behaviour. Ambivalence among drug users is evident in an awareness of potential costs as well as benefits; a tendency to avoid more harmful substances; a general emphasis on moderation; and a desire to use less. Building on previous work, which highlights the role of neutralisations in sustaining drug using behaviour, particular attention is paid to users' judgements about how their levels of consumption compare with other users. The analysis identifies a tendency among users to downplay their relative levels of use, which, it is argued, serves to shield them from some of the imperatives that may lead to decisions to cut down. As such, normalisation is said to be an intra-personal as well inter-personal process. The article concludes by discussing the potential of web-based personalised feedback as a harm reduction approach.

A bewildering range of recreational drugs exists and the majority have cardiovascular effects. In the United Kingdom almost a fifth of young people used illegal drugs between 2011 and 2012. As a group, recreational drugs account for a leading cause of mortality and morbidity among the young, and this is frequently via cardiovascular complications. This chapter profiles the cardiovascular properties of major recreational drugs in use at present, including cocaine, amphetamine-like compounds (e.g., MDMA), heroin, cannabis, LSD, inhaled volatile substances, and the scant information that exists on newer “designer drugs” and “legal highs.” Treatment for cardiovascular complications is also covered with up-to-date guidance. Cocaine’s cardiovascular risk profile is perhaps the most studied and its propensity to precipitate myocardial infarction in young, healthy adults is well known. However, it exerts its effects via a complex interplay of systems, an understanding of which is vital to guide management of the patient presenting with a cocaine-induced cardiovascular emergency. The risks of “body packing” and polydrug abuse are also covered.

Use of recreational drugs and other substances in women of childbearing potential is common and enquiries regarding the fetal risks following inadvertent exposure during early pregnancy are therefore also frequent. Misuse of drugs throughout or in later pregnancy may also impact on fetal well-being, and in some cases confer a risk of potentially serious effects in the neonate, such as neonatal withdrawal. Data demonstrating the extensive and lifelong problems associated with in utero exposure to alcohol are now vast and have been fundamental in informing the development of programs to reduce maternal alcohol use in pregnancy, and to improve diagnosis of fetal alcohol spectrum disorders in exposed individuals to enable early assessment and intervention. Unfortunately, the full fetal effects of drugs such as cannabis, opiates, amphetamines, cocaine and hallucinogens remain to be determined and use in pregnancy is therefore not advisable. This chapter summarizes the published literature regarding the fetal risks associated with maternal use of recreational drugs, cigarettes, caffeine and alcohol during pregnancy, the latter in the context of both regular and binge-drinking. Where applicable, recommendations regarding additional fetal monitoring or interventions are provided.

As breastfeeding is contraindicated in cases of persistent maternal use of heroin or stimulant drugs, such as amphetamines, cocaine and alcohol, breastfeeding mothers should avoid recreational drug use wherever possible. Nevertheless, the value of breastfeeding to both mother and infant could outweigh the risks associated with most maternal recreational drug use. These risks should be discussed on a case-by-case basis with the mother, with pragmatic advice given specific to her personal situation. Breastfeeding mothers should also be strongly discouraged from smoking or at least encouraged to reduce the number of cigarettes smoked to a minimum. This chapter addresses the effects that recreational drugs have on a breastfed infant.

The emergence of ever-novel psychoactive substances on the recreational drug market is an ongoing challenge for analytical toxicologists. If still unknown, their structure must first be elucidated. Once this has been achieved and reference substances have become available, it is important that laboratories working in the field of clinical and forensic toxicology either update existing methods or develop new ones that cover the novel psychoactive substances (NPS). This chapter provides an overview of analytical methods for analysis of NPS in biological matrices such as blood, urine and hair and discusses pitfalls and interpretative issues. It includes analytical methods covering compounds from several drug classes as well as methods dedicated to analysis of compounds from the following drug classes: piperazines, 2,5-dimethoxyphenethylamine-derived drugs (2Cs), 2,5-dimethoxyamphetamine-derived drugs, 4-substituted amphetamines, β-keto-amphetamines (cathinones), pyrrolidinophenones, tryptamines, and synthetic cannabinoid receptor agonists. Finally, some recommendations for setting up procedures for analysis of NPS are given.

Ketamine was introduced as an anaesthetic in the 1960s and continues to be used therapeutically both as an anaesthetic and also increasingly in pain management. In addition to use in humans, ketamine is widely used as an anaesthetic in veterinary medicine. It is used in research as a pharmacological model of schizophrenia. In recent years, ketamine has increasingly been used as a recreational drug. Though it is now a controlled substance in many countries in the world due to its psychotropic properties, its use as a recreational drug has become a worldwide phenomenon. In addition to the risk of acute toxicity associated with ketamine use, long-term ketamine toxicity can produce significant adverse effects and consequently lead to a burden on healthcare resources. In this chapter, we summarize the pathological changes in the different organs of animal models and humans, including its toxicity on central nervous system (CNS), urogenital system, intestine, pancreas, adrenal gland, liver, heart and immune system. The effects on the combination of ketamine and alcohol were also addressed in a number of the models of chronic ketamine toxicity. This is followed by a summary of the human data on patterns of acute and chronic toxicity reported from recreational and dependent use of ketamine.

Mephedrone (4-methylmethcathinone) is one of a number of synthetic cathinones that have emerged as novel psychoactive substances (NPS) since 2005/6. This chapter will focus on mephedrone as it is the most widely used cathinone and the one for which there is the most published literature. Mephedrone is most commonly available in powder form, but it is also available as tablets and capsules. The most common routes of use are nasal insufflation and oral ingestion: there are also reports of use by rectal insertion and intravenous/intramuscular injection. Users commonly report re-dosing during single-use sessions with total doses per session typically being 0.5–7.0 g. Data on population level prevalence of use of mephedrone is only available from the UK from 2010; this shows similar prevalence of use to ecstasy. A number of subpopulation surveys, mainly in the UK, elsewhere in Europe and Australia, have investigated the prevalence of use of mephedrone in other groups and shown that it appears to be more commonly used in the men who have sex with men population, in children of school age and those who frequent the night-time economy; although there have been regional differences in use patterns in some of these studies. There is limited data available on the pharmacokinetics of mephedrone, other than on its metabolism which has been investigated in both animal and human studies. A number of recent animal studies have investigated mechanisms of action of mephedrone. These suggest that, overall, mephedrone has similar actions both at a cellular and whole animal model level to other stimulant recreational drugs such as cocaine and amphetamine. Data is available on the patterns of acute toxicity of mephedrone from user reports on Internet drugs discussion fora, from calls to Poisons Information Services and from published case reports/case series of presentations to hospital with acute mephedrone toxicity (including one analytically confirmed series). Triangulation of data from these sources shows that mephedrone is associated with sympathomimetic (stimulant) toxicity in a similar pattern to that seen with 3,4-methylenedioxymethamphetamine (MDMA), amphetamine or cocaine. There have mephedrone-related deaths reported from the UK, Sweden, Netherland and Italy; there are also reports of mephedrone detection in fatalities from other countries in Europe and the USA, although it is difficult to be certain of the role of mephedrone in many of these fatalities. Data from both animal studies and largely anecdotal human reports suggests that mephedrone can be associated with psychological dependence, similar to that seen with other stimulant recreational drugs such as MDMA and cocaine.

Benzofurans are members of the amphetamine and phenylethylamine classes. 6-APB and 5-APB have recently been identified as single furan ring benzofuran compounds used as recreational drugs, producing sympathetic system stimulation and euphoria. There is little information available regarding their toxicity. They are postulated to exert their effects through stimulation of catecholamine receptors and as 5-HT receptor agonists. Benzodifurans (containing 2 heterocyclic rings) including bromo-dragonFLY and 2-CB-FLY are ring-substituted phenylethylamines with potent 5HT2A agonist effects and predominant hallucinogenic clinical effects. Bromo-dragonFLY toxicity produces excess sympathomimetic activity and severe vasoconstriction, in some cases resulting in limb amputation. Deaths secondary to bromo-dragonFLY and mis-identified 2-CB-FLY (containing bromo-dragonFLY) have occurred in Europe and the USA. Recent surveys of drug users indicate that 6-APB is the most commonly used recreational benzofuran in the UK; although compared to established, classical recreational drugs and other novel psychoactive substances 6-APB and other drugs in this class are rarely used.

Natural product novel psychoactive substances (‘legal highs’) are psychoactive plants or fungi that can be easily acquired from the Internet or retail outlets known as head shops without legal restriction. These materials are either stimulant-, hallucinogenic- or analgesic-like in their effects (or a combination) and many contain phenylethylamine- and tryptamine-derived natural products that are responsible for their pharmacological action. Unfortunately in many cases the chemistry of these materials was studied some time ago and up-to-date chemical and pharmacological analysis of these complex materials is absent, with little understanding of their effects singularly or in combination with other recreational drugs. This chapter covers the chemistry of fungal and herbal novel psychoactive substances and gives an overview of what is currently known of their pharmacology and toxicology. The legality of these materials will vary from country to country and over a period of time as their popularity varies and their adverse effects become better understood.

Publisher Summary This chapter focuses on the historical perspective of drug use among athletes, elaborates on the reasons athletes use substances, and describes in detail both specific performance-enhancing and recreational drugs. Since the advent of competitive sports, athletes have tried to gain an advantage over their competitors. One such advantage included the use of performance-enhancing drugs to allow athletes to extend their skills beyond their natural capabilities. In modern times, when the use of such exogenous substances has been made illegal, many athletes often make headline news on either the confession of or the determination of using performance-enhancing drugs through laboratory testing, which can cause professional disgrace. The financial incentives for taking performance-enhancing drugs are significant and enticing. Beside the conspicuous nature of an increasing salary, the benefits of performance-enhancing drugs also spill over into the psychological realm. The competitive nature inherent in sports can influence individual peak performance, more commonly referred to as “being in the flow.” Athletes possess a perceived benefit of increased alertness, awareness, responsiveness, and overall ability to function under the influence of ergogenic substances like cocaine, caffeine, ephedra, and amphetamines. The motivation by athletes for alcohol consumption includes social interaction, coping, and performance categories, which differs by sport. Despite the high rates of alcohol abuse by athletes and higher rates of binge drinking in athletes, alcohol largely adversely impacts athletic performance by decreasing aerobic performance, causing higher rates of injuries, dehydration, mood instability, and sensory motor system dysfunction.

This chapter addresses the toxic effects of the mixtures of two recreational toxins, ethanol and tobacco. These are the most abused chemicals in the world and both are used recreationally worldwide. There are many other recreational drugs in use. These include marijuana, cocaine, heroin, and methamphetamines, for example. The subject of this chapter is a substantial volume of information that describes unanticipated toxic effects of ethanol and tobacco when used in conjunction with other toxicants. The use of alcohol is deeply ingrained into most of the cultures of the world. It is consumed by vast numbers of people for religious and recreational purposes. It is seen that ethanol exacerbates the effects of other toxicants when consumed with these and induces effects not associated with exposures to the individual toxicants, nor with ethanol alone. The effects of mixtures containing ethanol are examined in this chapter. It provides the examples of the effect of ethanol on nutritional components and drugs that are caused by metabolic induction. Chronic consumption of ethanol increases the risk of some cancers. These include cancer of the throat, esophagus, pancreas, small intestine, colon, and liver. However, smoking causes 30% of all cancers and 87% of lung cancers. Tobacco products and tobacco smoke contain thousands of individual toxic compounds. Some of these chemicals have known toxicities, but the mixture produces effects that are often not anticipated from the toxicology of the single compounds. Finally it should be noted that the toxic effects induced by both ethanol and tobacco can be entirely prevented by the cessation of their use.

Publisher Summary The developing fetus and the growing child are at greater risk than are adults from exposures to neurotoxic chemicals. A large number of individual chemicals are recognized developmental neurotoxins. These include heavy metals, alcohol, and other solvents, recreational drugs (e.g., nicotine and cocaine), pesticides, and some pharmaceuticals. The central nervous system is the most vulnerable of all body systems to developmental injury, and developmental neurotoxic effects to it are influenced by the timing of the exposures as well as the dose. Exposures during the development of a particular part of the nervous system can have extreme effects, whereas the same exposures at other times can be benign. Exposures to developmental neurotoxins are believed to be responsible for the staggering numbers of affected children. This chapter provides an overview of the literature on the mixture neutroxicity. The studies so far have demonstrated enhanced or unanticipated neurotoxic effects following mixture exposures.

Publisher Summary This chapter examines the placebo-controlled and observational studies of drugs of abuse. The long history of marijuana use both as a recreational drug and as an herbal medicine for centuries has been reviewed. In an open trial the safety, tolerability, dose range, and efficacy of the whole-plant extracts of Cannabis sativa were evaluated in 15 patients with advanced multiple sclerosis and refractory lower urinary tract symptom. In a parallel group, double-blind, randomized, placebo-controlled study undertaken at three sites in 160 patients with multiple sclerosis a cannabis-based medicinal extract containing equal amounts of delta-9-tetrahydrocannabinol and cannabidiol at doses of 2.5–120 mg of each daily in divided doses for 6 weeks, spasticity scores were significantly improved by cannabis. The criteria for the interpretation of cocaine concentrations in biological samples and their relation to the cause of death have been comprehensively reviewed. It is found that necrotizing fasciitis, a rapidly progressive soft tissue infection with high morbidity and mortality, is most commonly associated with drug abuse by injection.

Human Immunodeficiency Virus (HIV)/ Acquired Immunodeficiency Syndrome (AIDS), was first recognized in homosexual men, has evolved to the current worldwide pandemic which now includes heterosexuals and children. The main risk factors are now unprotected sex, recreational drug injections, and infected mother-to-offspring transmission. Currently, the scope of the pandemic is enormous and appears to be increasing, and is spreading to Asia and Europe. Sexual transmission is prevented primarily by condom use. The risk from illicit drug use is needle-sharing among addicts, and the methods of control are withdrawal treatment, and various needle exchange programs. Maternal-to-newborn infection can occur either transplacentally or via breastfeeding, and can be controlled by antiviral treatment of the mother and newborn by using bottle-feeding. Currently, there are two classes of antiviral agents in use: the reverse transcriptase inhibitors, which interfere with the enzyme needed for viral nucleic acid synthesis, and the protease inhibitors, which block protein synthesis. These drugs in various combinations constitute HAART (highly active antiretroviral therapy).

Cocaine, a naturally occurring plant-derived alkaloid, has been used for centuries as a medicinal product. For thousands of years in South America, the leaves of the coca plant (Erythroxylon coca) have been chewed for treatment of various ailments. In 1860, the pure alkaloid form was isolated and became a popular constituent of various beverages, pharmaceuticals, and therapeutic tonics, but it was banned from these products in the United States in 1914. At the peak of the cocaine epidemic in the early 1990s, it was estimated that 5 million people used cocaine regularly in the United States. The drug is still popular, with up to 1.6 million current users of cocaine reported as of 2009. This is a decrease from 2.3 million users in 2003, but the consequences of recreational cocaine use are still profound. Cocaine is implicated in violent deaths and was detected in 25% of autopsies of fatal injuries in adults aged 15 to 44 years. In 2009, 39% of drug misuse deaths were due to cocaine. According to the Drug Abuse Warning Network, there were more than 423,000 cocaine-related emergency department (ED) visits representing 52% of drug abuse or misuse cases. As of 2009, cocaine ranked within the top three causes of illicit drug–related deaths at various cities across the United States. Amphetamines are stimulants originally designed for use as decongestants and dietary aids that became popular as recreational drugs in the mid-20th century. By modification of the amphetamine molecule, illicit “designer” amphetamines are inexpensively produced. The enhanced effects from these alterations add to the popularity of drugs such as 3,4-methylenedioxymethamphetamine (MDMA) and methamphetamines. Cocaine, amphetamines, and derivatives of amphetamines are called sympathomimetics (Box 154-1). These agents cause central nervous system (CNS) stimulation and a cascade of adrenergic physiologic effects. As of 2009, there were 502,000 methamphetamine current users in the United States.

MacCoun - 1 IS THE ADDICTION CONCEPT USEFUL FOR DRUG POLICY? Robert MacCoun * The development of behavioral economics, with its prospect of integrating insights from economics and psychology, is surely one of the most exciting intellectual developments in the social and behavioral sciences in the past 20 years. And if any domain could benefit from this development, it would seem to be the domain of psychoactive drug use, where choices are so often pathological. Thus, one can imagine my surprise and dismay when I was asked to prepare an essay on new policy insights that might follow from the leading behavioral economic theories of addiction 1 , and I discovered that there weren’t any. Or at least, hardly any. In this essay, I present evidence for that assertion, offer some speculative hypotheses about why it is true, and ask whether it is likely to remain true in the future. Some evidence As evidence, I offer the behavioral record – the behavior of professional drug policy analysts, in the form of two lengthy monographs on drug policy, both of which were published in 2001. Both monographs were prepared by interdisciplinary teams that included both psychologists and economists. I should emphasize that “the psychologist” in both cases was me. The first is my recent book with Peter Reuter, Drug War Heresies: Learning from Other Vices, Times, and Places (MacCoun & Reuter, 2001). The book is a comprehensive analysis of alternative legal policy regimes for controlling marijuana, cocaine, heroin, and other recreational drugs. 2 It is thoroughly interdisciplinary in scope -- Peter is an economist, I am an experimental social psychologist by training, and our collaborators included the economist Tom Schelling and